Minimizing Complications Lumbar Facet Block/RFA

Minimizing Complications

Lumbar Facet Block/RFA

AAPM 36th Annual Meeting

Samer Narouze, MD, PhD

Professor of Surgery, Anesthesiology and Pain Medicine, NEOMED and OUCOM

Clinical Professor of Neurological Surgery, OSU

Chairman, Center for Pain Medicine

Western Reserve Hospital

Cuyahoga Falls, OH

I have no relevant financial relationships with industry to disclose

#AAPM2020

AAPM 36th Annual Meeting

@NarouzeMD

Learning Objectives

1. Identify the most common complications from lumbar facet

interventions

2. Analyze the risk factors and apply risk mitigation strategies.

3. Develop a shared decision approach

#AAPM2020

AAPM 36th Annual Meeting

@NarouzeMD

Disclosures

Practice

Guidelines

RAPM

2020

? 17 questions were selected for guideline development by dozen societies

? 100% consensus achieved by committee members on all topics.

? All societies except for one approved every recommendation, with one

society dissenting on two questions (number of blocks and cutoff for a

positive block before RFA), but approving the document.

@NarouzeMD

QUESTION 15: WHAT ARE THE MOST COMMON COMPLICATIONS

OF FACET INTERVENTIONS, AND HOW CAN THEY BE MINIMIZED?

? Vascular penetration and injury

? Procedure-related pain and dysesthesias

? Injury to non-target neural structures in proximity to

the RFA probe

? Consequences of denervating surrounding muscles

? Impact on implanted electrical devices including

pacemakers, cardioverter defibrillators, DBS/SCS,

spinal instrumentation.

@NarouzeMD

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